Medical Doctors Debate Over Plantar Fasciitis Causes. WHY?

But while plantar fasciitis is not well understood, medically as pointed out in NY Times issue in 2013*.   Medical experts agree that plantar fasciitis is the the plantar fascia is irritated.  This fascia attaches at the heel and goes all the way up to the top portion of the toes.   Pain is most common in the morning after the fascia has tightened during the night.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

Many doctors believe repetitive movements like running, jumping, standing will cause inflammation in the fascia.  This can become chronic and it is really painful and can prevent people from working if they have to be on their feet for any period of time.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.  According to Dr. Karim Khan “Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

He believes it is caused most likely by degeneration or weakening of the tissue.  Small tears occur and the tissue.  The small tears don’t heal correctly and begin to accumulate leading to shredding and more tearing which leads to pain.

Dr. Philbin states that people can be pain free within a few months with injections or other invasive treatments.  they must do less running, jumping, walking and stretch the foot involved along with the achilles tendon and hamstrings.

Well, I have been working with people with Plantar Fasciitis for years and in my opinion, it is not the activity, it is the foot.  How a person lands on their foot while walking or running needs to be addressed along with what kind of shoes they wear.  They need a good support of the arch and the heel needs to be supported properly.

Yes, rehab is necessary and what I do is adjust the foot, teach patients about proper shoes and proper walking, stretching and soft tissue work.  I also get them to buy orthotics that help them land on their feet properly.  Shots are not going to solve the problem, just cover numb the pain.  With a little bit of time, the pain goes away and the patient now knows how to take care of their feet.  This seems much better than shots or surgery which can slow down healing and sometimes lead to more pain or no change at all.